HomeMy WebLinkAboutMiscellaneous - 10 FIELDSTONE COURT 4/30/20183 0( 5
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Date .... �/ - /11�
TOWN OF NORTH ANDOVER
0 PERMIT FOR WIRING
This certifies that ....... ......... v ...... ........ F .....
has permission to perform ..................... 5 .. j . . ..............................
UUA ... a., ...... ...........
1wiring in the building of ......... ... ....
r� "-4 , , f 12J- —* * .. ......
....................... ( ...................... .............. orth Andov
or,
Lic. ............ n ....
... ...... ...............
Check # /1"EcTRICAL INSPECTOR
Official Use Only
- cc�� Permit No.
k 20parllnsni alg ire Basic" —
�'= BOARD OF FiRE PREVENTION REGULATIONS Ovcupancy..and Fee Checked
Rev. 11/99]
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perl'ormcd in accordance with the Massachusetts Elccirical Code (EIEC), 527 CMR 12.00
(PL EASE• PRItVTININK ORTYP'EALLi FOIWAT•ION) Onle: � dZ
City or Town of: To Ilse Inspector- of Wires:
By this application [lie undersigned gives nonce ofhis or her intention to perform the electrical work described
below,
Location (Scree! �E Number) /Q •►" lQ �j'4,/�S�ld1,t[ C 7.
Owner or Tenant U) &34 12.141'AQW1 ra C
��— Telephone No. _47R,� • .7Qr�3
Owner's Address_ 0 Wdodtlif5ie, p2oA
Is this permit in conjunctioli with a building permil? Yes No
,I ❑ C%� (Check Appropriate Box)
1'urliose of Building 74e 414. 1a.1 Wilily Authorization No.
Existing Service V64 AnrpsVolts Overliead n
; / �% ❑ Uudg. 18J No. of Meters .
New Service SIAwIE Amps / Volts Overhead ❑. Undord
b ❑ No. oCitiletcrs.•
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
ret 91 41j;
Conn letiorr o(the (olio,vine table ma be haired b + the leis cclor o(Mres.
No, of Recessed Fixtures No. of Ceii.-Susp. (Paddle) Fans °' ° otaI
Transformers KVA
No, of Lighting Outlets No. of Iiot Tubs Generators MIA
Attach additional detail if desired, or as required by the Inspector of wires.
IiVSUR- INCE C01' ERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is fn force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSUItjkNCE Q/ BOND ❑ OTHER ❑ (Specify:)6j���y(
�0 3
Estimated Value of Electrical Work: (When required by municipal policy.) (Exp ation Date)
Work to Start: .� O Z. Inspections to be requested in accordance with IMEC Rule 10, and upon completion.
I cerrifj , punter the pains and penalties of perjttq; tltttt t/re itrforrnation on !itis trpplication is true and cotrrpl��te:
FtRDI NAME:- �- t ud �c -c
� LIC. NO.: l�yyl"A-
Licensee: liiG �� E^ Signature -
(ifapplicable, eruct-exclapt" i t die license
n auber line , LIC. itiO.:�aOS3l�
Address: �aX a r � • O 3 Bus.Tel.No:-
ONVNER' INSUR:�tiCE NVAIVER: 1 am aware that the Licennsee does not have the liability ins�lturance o1 crave norn$ly
required by law. B\ my signature below, i hereby waive this requirement. I am the (check one) ❑owner ❑ owner's as eat:
Owner/Abent
Sibnatw•e 'Telephone No. PI:Rt1fIT I'EE; —'
No. of Lighting Fixtures
No. of Receptacle Outlets
Swimming Pool Above ❑ lu- ❑mergency
rnd. rnd.
No. of Oil Burners
tg i mg
'D Units
F17
FIRE ALARiiIS
No. of Zones
No. of Switches
No. of Ranges
No. of Gas Burners
No. of Air Cond. total
Tons
0. 0 Detection and
Initiating Devices t
No. of Alerting Devices
No. of Waste Disposers
No. of Dishwashers
Heat Yunip tyuniber tons K�
Totals: _• _ — -
Space/Area Heating K1V
No. oCSel - 11 1!11
Detectiolt/Alerting Devices
Local (] unicipa
Connection C1 Other
Security Svstems:
No, of Devices or Equivalent
Data Wiring -
of llevices or E uivalent
leleconmmntcations 'iring:
N0. of Devices or E uivalent
No. of Drti•ers
Heating Appliances KW
t o. of Water
Heaters KW
No. of No. oC
Sioiu Ballasts
2211S
No. Hydroniassage Bathtubs
OTHER:
No. of Motors Total I1P
Attach additional detail if desired, or as required by the Inspector of wires.
IiVSUR- INCE C01' ERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is fn force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSUItjkNCE Q/ BOND ❑ OTHER ❑ (Specify:)6j���y(
�0 3
Estimated Value of Electrical Work: (When required by municipal policy.) (Exp ation Date)
Work to Start: .� O Z. Inspections to be requested in accordance with IMEC Rule 10, and upon completion.
I cerrifj , punter the pains and penalties of perjttq; tltttt t/re itrforrnation on !itis trpplication is true and cotrrpl��te:
FtRDI NAME:- �- t ud �c -c
� LIC. NO.: l�yyl"A-
Licensee: liiG �� E^ Signature -
(ifapplicable, eruct-exclapt" i t die license
n auber line , LIC. itiO.:�aOS3l�
Address: �aX a r � • O 3 Bus.Tel.No:-
ONVNER' INSUR:�tiCE NVAIVER: 1 am aware that the Licennsee does not have the liability ins�lturance o1 crave norn$ly
required by law. B\ my signature below, i hereby waive this requirement. I am the (check one) ❑owner ❑ owner's as eat:
Owner/Abent
Sibnatw•e 'Telephone No. PI:Rt1fIT I'EE; —'
31 Date...,....
t&ORTN TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ...................
has permission for gas installation ... ...... .........
in the buildings of ... J. A. 2'.
at ............... North Andover, Mass.
Fee..!.�.-. . . Lic. No.. .......
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
.N
MASSACHUSETTS UNIFORM APPUCATON FOR
or print)
NORTH ANI
Building Locations
t, MASSACHUSETTS 1A)
q ..11 ``OVAi t/J�W n -f_ 1. *-r
Aj D j 0` d( e Du d"9 S Owner's Name
MAP
PARCEL
DO GAS F1TI'ING
Date - P 02 A
/L Z�-
New ❑ Renovation ❑ Replacement rM Plans Submitted ❑
Permit # ! 3 ?
Amount $ I
(Print or type)' t _ A dl (/
Name 11 li'V
Address d V f
Rncine,cc Telenhnne e, `1 // /_ P' f `7
Name of Licensed Plumber or Gas Fitter
k one: Certificate Installing Company
Corp.
❑ Partner.
❑ Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes P No❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity ❑ Bond ❑
Owner's Insurance Waiveram aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installatioerf under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts S t e Chapter 142 of the General Laws.
ICity/Town
IAYYKV V l;li (OFFICE USE ONLY) '
Signature of Licensed Plumber Or Gas Fitter
Plumber j 7_ Z ! S
Gas Fitter License Number
Master
Journeyman
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SUB-BASEM ENT
B A S E M ENT
1ST. FLOOR
2ND. FLOOR
3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
6TH. FLOOR
7TH. FLOOR
8TH. FLOOR
(Print or type)' t _ A dl (/
Name 11 li'V
Address d V f
Rncine,cc Telenhnne e, `1 // /_ P' f `7
Name of Licensed Plumber or Gas Fitter
k one: Certificate Installing Company
Corp.
❑ Partner.
❑ Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes P No❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity ❑ Bond ❑
Owner's Insurance Waiveram aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installatioerf under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts S t e Chapter 142 of the General Laws.
ICity/Town
IAYYKV V l;li (OFFICE USE ONLY) '
Signature of Licensed Plumber Or Gas Fitter
Plumber j 7_ Z ! S
Gas Fitter License Number
Master
Journeyman